Deprescribing

The process of withdrawal of an inappropriate medication, supervised by a health care professional, with the goal of managing polypharmacy and improving outcomes.
It concerns the overuse of medications, or use of certain ones for too long — in general, polypharmacy.
Polypharmacy and the potentially inappropriate use of medications have been associated with many negative health outcomes, including reduced quality of life, adverse drug reactions, addiction, falls, nonadherence, hospitalizations, and mortality.
Other benefits of deprescribing may include reduced cost and perhaps improved patient adherence.

It is done by following a stepped process.

1) Assess.
- medication history
- the patient's adherence to the medications
- the risks and benefits depending on individual patient factors
- the goals of care of those medications and their continuation
- drug-related factors: polypharmacy, pill burden, medication regimen, drug/drug interactions, the use of specific high-risk drugs
- patient factors: life expectancy, cognitive and functional factors, impairment the medications are causing, multiple prescribers

2) Conclude.
- which medications are most important to the patient
- which are potentially inappropriate medications
- which medications do not have a specific indication
- which medications have questionable efficacy or alters risk when combined with other medications

3) Plan.
- what to start with first
- the appropriate time
- the tapering or withdrawal process
- the control of benefits and harms of medication withdrawal

Web resources with useful guidelinesBeers criteria https://geriatricscareonline.org/ProductAbstract/american-geriatrics-society-updated-beers-criteria-for-potentially-inappropriate-medication-use-in-older-adults/CL001Deprescribing.org https://deprescribing.org/Medstopper http://medstopper.com/Risk: making medicines safer for all of us https://rxisk.org/STOPP/START criteria https://academic.oup.com/ageing/article/44/2/213/2812233

See reference for more information.

Adapted from Medscape News & Perspective. Targeting unnecessary meds: A guide to deprescribing. Internet. Available at https://www.medscape.com/viewarticle/880516?src=wnl_edit_tpal&uac=6705FY#vp_1 . Accessed on April 29, 2018. To view the entire article and all other content on the Medscape News and Perspective site, a free, one-time registration is required.

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